Joyous Birth? Baby Dies During Home Delivery
Barbara Lock, MDApril 08, 2009
Reports surfaced this week of the death of the baby of homebirth advocate Janet Fraser after several days of labor in her Australia home, according to the Sydney Morning Herald. Ms. Fraser, one of the principals behind the homebirth organization Joyous Birth, has described the invasive measures associated with hospital deliveries, including C-section and episiotomy, as 'birthrape.' In an article about 'birthrape', she writes:
When you slash a woman's vagina with scissors and she's screaming no, that's rape and on the street it would earn you a gaol sentence. Your green gown is not protection, do that to me and I will charge you."
The circumstances of the death of Ms. Fraser's baby during home delivery are not reported.
Having a baby is a risky proposition, even in the developed world. While a study in the British Medical Journal found no increased risk for mother or child for low risk home deliveries, other studies have demonstrated substantial risk. According to data gleaned from a study of planned home births in England and Wales between 1994 and 2003 by Mori et al, having a home birth results in a preventable death of the mother in one of every 2040 cases, compared to opting for a hospital delivery. A little more than 1 out of 1000 women who chose homebirths died.
A study of homebirths in Oregon State from 1989 to 1996 by Pang et al found similar risks for infants: infants of planned home deliveries were twice as likely to die as infants of planned hospital deliveries. Women who had never delivered a baby before (nulliparous) who delivered at home were also more likely to have prolonged labor and severe bleeding than those who delivered in a hospital. Women who had delivered a baby before had no increase in prolonged labor or severe bleeding.
Lindgren et al reported an infant mortality rate of 2.2 per thousand for home births and 0.7 per thousand for hospital births in Sweden. The risk difference is .15 %. That means that having a home birth resulted in a preventable death of the infant in one out of every 666 cases. That's not a reassuring number.
In a separate report, Lindgren et al evaluated women's understanding of risks and benefits of home births. Women who chose home birth feared loss of autonomy and control, and unnecessary interventions, in going to a hospital. They feared worst-case scenario health disasters in staying home, but managed these fears by avoiding a conversation about them with their doctor.
Women who wish to have a home birth may wish to consider waiting until a first normal vaginal delivery in a hospital setting, and then have a frank and open discussion of the risks and benefits of home delivery with an obstetrician, before going forward.
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